The total cost of treatment was 31% less using PBPCs primed with
filgrastim (G-CSF, Neupogen). "It is rare in this day and
age to find a procedure that is not only more effective but also
more cost effective," said Dr. Smith, of the Medical College
of Virginia, Massey Cancer Center, Richmond.

The economic study was based on data from a prospective randomized
clinical trial performed at seven centers in four European countries.
This trial compared the two transplant methods in 72 patients
with relapsed Hodgkin's disease or non-Hodgkin's lymphoma (37
randomized to receive PBPC and 35 to receive ABMT). Peripheral
blood progenitor cells were collected after mobilization by filgrastim.

In this trial, patients who received filgrastim-primed PBPC support
had significantly shorter hospital stays than those in the ABMT
arm (20 days vs 26 days, respectively); faster time to neutrophil
recovery (13 days vs 15 days); faster time to platelet recovery
(20 days vs 27 days); and fewer platelet transfusions (5 vs 12).
Exposure to blood products (and risk of HIV or hepatitis) was
markedly less in the filgrastim-primed PBPC patients. There was
no difference in safety between the two procedures, with one treatment-related
death on each arm.

The total estimated cost of treatment for the filgrastim-primed
PBPC patients was about $40,000, compared with $58,000 for the
ABMT group. The $18,000 savings resulted primarily from reduced
hospitalization.

"The PBPC patients were out of the hospital an average of
about a week sooner," Dr. Smith said. He added that the savings
far exceeded the costs of filgrastim priming and PBPC collection.

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